Definition

What is low sperm count?

Low sperm count means that the fluid (semen) you ejaculate during an orgasm contains fewer sperm than normal.

A low sperm count is also called oligospermia. A complete absence of sperm is called azoospermia. Your sperm count is considered lower than normal if you have fewer than 15 million sperm per milliliter of semen.

Having a low sperm count decreases the odds that one of your sperm will fertilize your partner’s egg, resulting in pregnancy. Nonetheless, many men who have a low sperm count are still able to father a child.

How common is low sperm count?

Low sperm count is extremely common. It can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Decreased facial or body hair or other signs of a chromosome or hormone abnormality

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

You should contact your doctor if you have any of the following:

Erection or ejaculation problems, low sex drive, or other problems with sexual function

Pain, discomfort, a lump or swelling in the testicle area

A history of testicle, prostate or sexual problems

Groin, testicle, penis or scrotum surgery

Causes

What causes low sperm count?

The production of sperm is a complex process and requires normal functioning of the testicles (testes) as well as the hypothalamus and pituitary glands — organs in your brain that produce hormones that trigger sperm production. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. Problems with any of these systems can affect sperm production. Also, there can be problems of abnormal sperm shape (morphology), movement (motility) or function.

Low sperm count can be caused by a number of health issues and medical treatments. Some of these include:

A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility. Varicoceles result in reduced quality of the sperm.

Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm.

Ejaculation problems. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause retrograde or lack of ejaculation, including diabetes, spinal injuries, and surgery of the bladder, prostate or urethra.

Certain medications also might result in ejaculatory problems, such as blood pressure medications known as alpha blockers.

Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.

Cancers and nonmalignant tumors can affect the male reproductive organs directly. Surgery, radiation or chemotherapy to treat tumors can also affect male fertility.

Undescended testicles. During fetal development one or both testicles sometimes fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men with this condition.

Hormone imbalances. The hypothalamus, pituitary and testicles produce hormones that are necessary to create sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal gland, may impair sperm production.

Defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions.

Prior surgeries. Certain surgeries might prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others.

Sperm production or function can be affected by overexposure to certain environmental elements, including:

Heavy metal exposure. Exposure to lead or other heavy metals also can cause infertility.

Radiation or X-rays. Exposure to radiation can reduce sperm production. It can take several years for sperm production to return to normal. With high doses of radiation, sperm production can be permanently reduced.

Overheating the testicles. Elevated temperatures impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs might temporarily impair sperm count.

Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also might increase the temperature in your scrotum and slightly reduce sperm production.

Other causes of low sperm count include:

Drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana might reduce the number and quality of your sperm as well.

Certain occupations might be linked with a risk of infertility, including welding or those associated with prolonged sitting, such as truck driving. However, the data to support these associations is inconsistent.

Tobacco smoking. Men who smoke might have a lower sperm count than do those who don’t smoke.

Obesity can impair fertility in several ways, including directly impacting sperm and by causing hormone changes that reduce male fertility.

Risk factors

What increases my risk for low sperm count?

There are many risk factors for low sperm count, such as:

Smoking tobacco

Drinking alcohol

Using certain illicit drugs

Being overweight

Having certain past or present infections

Being exposed to toxins

Overheating the testicles

Having experienced trauma to the testicles

Being born with a fertility disorder or having a blood relative with a fertility disorder

Having certain medical conditions, including tumors and chronic illnesses

Undergoing cancer treatments, such as radiation

Taking certain medications

Having a prior vasectomy or major abdominal or pelvic surgery

Having a history of undescended testicles

Diagnosis & Treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is low sperm count diagnosed?

When you see a doctor because you’re having trouble getting your partner pregnant, he or she will try to determine the underlying cause. Even if your doctor thinks low sperm count is the problem, it is recommended that your partner be evaluated to rule out potential contributing factors and determine if assisted reproductive techniques may be required.

Testing and diagnosis may involve the following:

General physical examination and medical history: This includes examination of your genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor might also ask about your sexual habits and your sexual development.

Semen analysis: A low sperm count is diagnosed as part of a semen analysis test. Sperm count is generally determined by examining semen under a microscope to see how many sperm appear within squares on a grid pattern. In some cases, a computer might be used to measure sperm count.

Depending on initial findings, your doctor might recommend additional tests to look for the cause of your low sperm count and other possible causes of male infertility. These can include:

Scrotal ultrasound. This test uses high-frequency sound waves to look at the testicles and supporting structures.

Hormone testing. Your doctor might recommend a blood test to determine the level of hormones produced by the pituitary gland and testicles, which play a key role in sexual development and sperm production.

Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).

Genetic tests. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might also be ordered to diagnose various congenital or inherited syndromes.

Testicular biopsy. This test involves removing samples from the testicle with a needle. The results of the testicular biopsy can tell if sperm production is normal. If it is, your problem is likely caused by a blockage or another problem with sperm transport. However, this test is typically only used in certain situations and is not commonly used to diagnose the cause of infertility.

Anti-sperm antibody tests. These tests, which are used to check for immune cells (antibodies) that attack sperm and affect their ability to function, are not common.

Specialized sperm function tests. A number of tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg and whether there’s any problem attaching to the egg. Generally, these tests are rarely performed and often do not significantly change treatment recommendations.

Transrectal ultrasound. A small lubricated wand is inserted into your rectum to check your prostate, and for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).

How is low sperm count treated?

For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.

For treating infections, antibiotics can cure an infection of the reproductive tract, but this doesn’t always restore fertility.

For treatments for sexual intercourse problems, medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.

Hormone treatments and medications. Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.

Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm are then inserted into the female genital tract, or used for in vitro fertilization or intracytoplasmic sperm injection.

Lifestyle changes & Home remedies

What are some lifestyle changes or home remedies that can help me manage low sperm count?

The following lifestyles and home remedies might help you cope with low sperm Count:

Increasing the frequency of sex. Having sexual intercourse every day or every other day beginning at least four days before ovulation increases your chances of getting your partner pregnant.

Having sex when fertilization is possible. A woman is likely to become pregnant during ovulation — which occurs in the middle of the menstrual cycle, between periods. This will ensure that sperm, which can live several days, are present when conception is possible.